Agenda item

This report provides an update on the NHS Medway Clinical Commissioning Group (Medway CCG) Community Services Re-Procurement Programme (CSR) following previous updates provided in June 2017 and October 2017.

Appended to the report is a substantial variation questionnaire which is presented to the Committee to determine whether the revised model for community services constitutes a substantial variation to health services in Medway.

Discussion

The report was introduced by the Chief Operating Officer of Medway of NHS Medway Clinical Commissioning Group (CCG) and by the Senior Programme Manager. The CCG was requesting that the Committee determine whether the re-procurement proposals amounted to a substantial development of or variation in the provision of health services in Medway. The CCG was legally required to re-procure the community health services included in work. A wide range of preparatory work was being undertaken in advance of the re-procurement.

A variety of public engagement had taken place during the previous three months with further engagement activity planned. Significant engagement would be undertaken regardless of whether the proposals were determined by the Committee to be a substantial variation.

Six large stakeholder events had taken place, which a number of Committee Members had attended. Feedback from each event was analysed in order to shape the next event. Patient Panels had been hosted at some of the events. These had gathered views from patient representatives, Healthwatch Medway and Involving Medway. In addition to the engagement events, the proposals had also faced challenge from the CCG itself and from NHS England

The CCG was already trialling ways of delivering urgent responses to frail elderly patients in order to avoid unnecessary hospital admissions. New multi-disciplinary teams were being trialled and some Pace Clinics had been established to support elderly patients. Work was taking place with a variety of providers to look at how patients with long term conditions could be better supported. Community nursing services were being reviewed to make improvements and an End of Life Strategy was being implemented.

The CCG was currently identifying which schemes that should be commissioned.

Members of the Committee asked a number of questions which were responded to as follows:

Engagement - The Chief Operating Officer said there was a risk that, should the Committee determine that the proposals were a substantial variation, that  this could result in a need for formal public consultation which could make the work take longer than planned.

It was acknowledged that there was a need to ensure more critical challenge in future engagement activity. Staff were broadly aware of the re-commissioning process and work required but it could not be guaranteed that all staff were as aware as they could be. Staff engagement so far suggested that there was a broad agreement regarding what was needed.

An agency, ‘Involving Medway’ had been commissioned to work with hard to reach groups and as many such groups would be engaged with as was reasonably possible. It was agreed that details of the cost of the engagement process would be provided to the Committee. It was suggested that the voluntary sector in Medway could act as a facilitator for engagement with hard to reach groups.

Needs of older people – A Committee Member was very concerned that older people often could not get the treatment they needed or were faced with very long waiting times. She suggested that addressing this should be a priority for health commissioners given the impact that a lack of treatment or lengthy waits could have on the overall wellbeing of people, the likelihood that this would actually increase the long term cost to the health and social care systems and that it could cause unnecessary social isolation.

Substantial Variation decision and patient needs – A Member of the Committee said that she would have liked more information on the impact of the substantial variation decision to have been included in the report and that she would also have liked to see a clearer timeline and implementation plan for the recommissioning. The Member also noted that the number of frail, elderly patients was relatively small compared to the total Medway population and therefore considered that there should not be too much difficulty in looking after this group, although it was accepted that the needs of this group were often high. The Committee was advised that there was a focus on elderly frail as this group tended to place the most demand on resources.

A Committee Member said that changes could be substantial even if they were changes that led to improved or expanded services. In particular, the Member considered that the proposals to change the location and accessibility of some  community health services and ten high impact changes, as detailed in the report, were significant.

Decision

To protect the Overview and Scrutiny statutory right to comment and with no intention of slowing down the recommissioning process, the Committee determined that the revised model presented was a substantial development of or variation in the provision of health services in Medway.